Prone positioning in acute respiratory distress syndrome after abdominal surgery: a multicenter retrospective study : SAPRONADONF (Study of Ards and PRONe position After abDOmiNal surgery in France).

Background: The recent demonstration of prone position's strong benefit on patient survival has rendered proning a major therapeutic intervention in severe ARDS. Uncertainties remain as to whether or not ARDS patients in the postoperative period of abdominal surgery should be turned prone because of the risk of abdominal complications. Our aim was to investigate the prevalence of surgical complications between patients with and without prone position after abdominal surgery.

Chest trauma: First 48hours management.

Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions.

The limits of succinylcholine for critically ill patients.

Background: Urgent tracheal intubations are common in intensive care units (ICU), and succinylcholine is one of the first-line neuromuscular blocking drugs used in these situations. Critically ill patients could be at high risk of hyperkalemia after receiving succinylcholine because one or more etiologic factors of nicotinic receptor upregulation can be present, but there are few data on its real risk. Our objectives in this study were to determine the factors associated with arterial potassium increase (ΔK) and to assess the occurrence of acute hyperkalemia ≥6.

Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients.

Purpose: To assess sublingual microcirculatory changes following passive leg raising (PLR) and volume expansion (VE) in septic patients.

Methods: This prospective study was conducted in two university hospital intensive care units and included 25 mechanically ventilated patients with severe sepsis or septic shock who were eligible for VE in the first 24 h of their admission. Pulse pressure variation (ΔPP), cardiac output (CO) and sublingual microcirculation indices were assessed at five consecutive steps: (1) semi-recumbent position (Baseline 1), (2) during PLR manoeuvre (PLR), (3) after returning to semi-recumbent position (Baseline 2), (4) at the time when VE induced the same degree of preload responsiveness as PLR (VE(∆PP = PLR)) and (5) at the end of VE (VE(END)).

Plasma-induced endothelial oxidative stress is related to the severity of septic shock.

Objective: To estimate the capacity of plasma from septic shock patients to induce in vitro reactive oxygen species (ROS) production by endothelial cells and to analyze whether ROS production is related to the severity of the septic shock.

Design: Prospective, observational study.

Setting: Medical intensive care unit in a university hospital.

One-day quantitative cross-sectional study of family information time in 90 intensive care units in France.

Rationale: Providing family members with clear, honest, and timely information is a major task for intensive care unit physicians. Time spent informing families has been associated with effectiveness of information but has not been measured in specifically designed studies.

Objectives: To measure time spent informing families of intensive care unit patients.

Beta2-adrenergic agonist protects human endothelial cells from hypoxia/reoxygenation injury in vitro.

Objective: Circulatory shock results in hypoxia/reoxygenation processes that lead to the release of reactive oxygen species, endothelial injury, and multiple organ failure. Previous data suggest that beta2-adrenergic agonists prevent endothelial dysfunction. The study aimed at determining whether the beta2-adrenergic agonist formoterol protects endothelial cells against hypoxia/reoxygenation injury in vitro.

Endothelial oxidative stress induced by serum from patients with severe trauma hemorrhage.

Objective: Shock induces oxidative stress by ischemia-reperfusion phenomenon. Endothelial cells are involved in the inflammatory response and oxidative stress responsible for microcirculation impairment and organ failure. We examined the potential of serum from patients to induce in vitro reactive oxygen species production by cultured human umbilical vein endothelial cells (HUVECs).

Risk of post-traumatic stress symptoms in family members of intensive care unit patients.

Rationale: Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD).

Objectives: Factors associated with these symptoms need to be identified.

Methods: For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role.

Half the family members of intensive care unit patients do not want to share in the decision-making process: a study in 78 French intensive care units.

Objective: To evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic.

Design: Prospective multiple-center survey of intensive care unit staff and family members.

Setting: Seventy-eight intensive care units in university-affiliated hospitals in France.